What is plantar fasciitis and why does it occur?
The plantar fascia is a long, thin ligament that runs along the bottom of the foot, connecting the heel to the front of the foot, and helps support the arch of the foot. Although designed to withstand significant forces, the plantar fascia can become stressed and strained leading to small tears and inflammation. While plantar fasciitis can result from overuse (most commonly seen in runners) and a sudden increase in activity, several other risk factors exist. These include tight calves, obesity, and theoretically heel spurs.
Heel spurs may actually be the result of and not necessarily the cause of the heel pain. Approximately only 5% of patients with heel spurs actually experience heel pain.
Pain on the bottom of the foot near the heel is the most common symptom. It is often severe with the first few steps in the morning, likened to a knife stabbing the heel. As we sleep, the plantar fascia and Achilles tendon normally contract. The first few steps in the morning result in the plantar fascia suddenly stretching and can exacerbate the small tears in the plantar fascia. The pain typically subsides after a few minutes of walking, but will once again appear if the patient engages in increased activity.
An x-ray is usually ordered to rule out fracture and any other bony pathology. An MRI may be ordered to further evaluate the foot in the case of persistent symptoms or to rule out other causes of pain.
Nonoperative management is considered the first line treatment for plantar fasciitis. Activity modification, NSAIDs such as Advil or Aleve (if not contraindicated), and physical therapy are the mainstays of treatment. Physical therapy focuses on improving Achilles/Calf flexibility and other modalities aimed at decreasing inflammation and healing the plantar fascia. The recovery process can be long, yet approximately 90% of patients will improve within 3-6 months of beginning nonoperative treatment.
Patients may also be referred to a Podiatrist to be fitted for custom orthotics. A night splint can be helpful to stretch the Plantar fascia and Achilles tendon while you are sleeping. This prevents exacerbation of those small tears in the plantar fascia with the first few steps in the morning.
Cortisone injections are in general discouraged by Dr. Steven Lee, given the chance for plantar fascia rupture, or heel pad atrophy. The heel pad is a specially designed cushion on the heel that can be melted by cortisone, especially with multiple injections. As a last resort, one cortisone injection may be given if symptoms are severe enough however.
Extracorporeal shockwave therapy (ESWT) is another option and usually employed as a last resort nonoperative treatment method given its inconsistent treatment results. During this procedure, high-energy shockwave impulses are directed at the plantar fascia in order to stimulate healing of the plantar fascia tissue.
Surgery is rare and usually only considered after prolonged, aggressive nonsurgical management, typically of at least 3-6 months.
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.